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PapillitisEpidemiologyPapillitis is a term used for disc edema (swelling) of uncertain etiology (cause). As such, there are no specifics to the race, gender or age of those affected. Papillitis may be unilateral or bilateral (one eye or both) and in some cases, such as inflammation or neoplasia (abnormal cell proliferation), occurs recurrently. Bilateral disc edema of uncertain etiology, even if associated with a headache, should be referred to as bilateral papillitis. Symptoms and signsPapillitis is associated with acute onset of visual loss. An afferent pupillary defect (abnormal pupil response to light), color desaturation (decreased perception of brightness) and central visual field defect is present. In contrast,papilledema (swelling of the nerve secondary to increased intracranial pressure) typically has normal optic nerve function early on. Papilledema does not typically present with decreased vision, an afferent pupillary defect, color desaturation or significant visual field defects. The most common visual field defect in papillitis is a central scotoma (field defect); early papilledema produces only an enlarged blind spot (which may be missed with the new automated fields). DiagnosisPapillitis may represent optic neuritis (inflammation of the nerve), which is often associated with the development If macular edema or a macular star (swelling of the macula) are present, the diagnosis is more likely infectious (e.g., cat scratch disease) rather than optic neuritis associated with MS. If cotton wool spots (white spots caused by microinfarcts) are present, the diagnosis is either malignant hypertension or vasculitis (inflammation of the blood vessels) such as Lupus Erythematosis or Temporal Arteritis. Papillitis may be idiopathic (no known cause), infectious, due to ischemia (loss of blood flow) or a tumor (optic nerve or sphenoid wing meningioma, glioma, or a mass in the parasellar region). Compressive lesions can also cause cavitation (optic nerve cupping) or shunt vessels on the surface of the disc. Temporal arteritis should be considered in all patients over the age of 50 years with a headache, especially when visual symptoms are present. In that disorder, transient visual obscurations may precede visual loss; vision may be poor (less than 20/400) unlike in patients with papilledema, in whom vision is typically good unless the papilledema is longstanding. Diplopia (double vision) due to cranial nerve impairment may also occur. The ocular signs may include optic nerve pallor, swelling, or cavitation. A branch or central retinal artery occlusion may also occur. Occasionally, both optic nerves become swollen in rapid succession and are inappropriately designated as papilledema (swelling only caused by increased intracranial pressure). ManagementThe management depends on the cause. Oral or intravenous corticosteroids are indicated in inflammatory papillitis, but oral corticosteroids are contraindicated as the initial treatment for optic neuritis. If temporal arteritis is suspected, bloodwork should be done to check for inflammation. Oral corticosteroids may then be used to treat the condition.
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of or co-existent, multiple sclerosis (MS). In contrast to the symptoms and signs of papilledema, optic neuritis is typically acute in onset and is associated with retrobulbar (behind the eye) pain that is worse with eye movement. Optic neuritis is not typically accompanied by headache or transient visual obscurations.More commonly optic neuritis is retrobulbar and the optic nerve is entirely normal in appearance. In addition, no visible abnormalities are present in the eye. 
